VAT on dental aligners — what the Upper Tribunal's decision means for dentists & dental laboratories

A recent Upper Tribunal (UT) tax decision has changed the VAT treatment of clear dental aligners and will affect dentists, dental technicians and dental laboratories who supply or provide clear aligners — either directly or through third party providers.

The VAT treatment of dental aligners has been the subject of ongoing tax litigation in recent years and the latest decision could have significant implications for suppliers and dental practices alike. The British Orthodontic Society (BOS) has already raised concerns that the change could increase the cost of orthodontic treatment and place further pressure on affordability and access to care.

Here, tax disputes expert Helen Pearson and Hewi Ma from our dental sector team explore the current position and outline what actions dentists and dental laboratories should consider taking.

The VAT exemption for dental treatment

If you're a dentist, dental care professional or dental technician providing dental care and treatment to a patient, you may exempt the onward supply of aligners. This has historically been the case and hasn't changed. This applies to both NHS and private dentistry.

What’s changed?

The key change is the VAT treatment of supplies made by aligner manufacturers, suppliers and dental laboratories.

These changes will also apply to other items that aren't a ‘replacement body part’, such as mouthguards, retainers, sports guards and splints.

Broadly, the VAT exemption applies where there’s:

1. a supply of dental care (i.e. from a dentist to a patient) by a registered dentist or dental technician, or
2. a supply of ‘dental prostheses’ from a registered dentist or dental technician.
    

Historically, some third party suppliers and dental laboratories charged VAT to dentists on the supply of these products, while others didn't.

HMRC's challenge & the tribunal decisions

In 2025, HMRC challenged the VAT treatment of Align's supply of clear aligners to dentists on the basis that clear aligners aren't ‘dental prostheses’ and Align had incorrectly supplied the aligners without charging VAT. HMRC’s position was primarily that, to be a ‘prosthesis’, it had to replace a body part. 

The First-tier Tax Tribunal (FTT) determined that the definition of ‘dental prostheses’ was broad enough to encompass clear aligners. Consequently, no VAT was due. This was determined on the basis that dental prostheses included devices that ‘aid’ or ‘supplement’ the body. 

However, the UT has now overturned that decision and held that aligners don’t fall within the definition of ‘dental prostheses’ and the sale of clear aligners from third party suppliers to dentists isn’t a VAT-exempt supply.

Accordingly, the current status of the law is that all suppliers of clear aligners should be charging VAT on supplies made to dentists, provided that they’re (or are required to be) VAT registered.

What does this mean for dental practice owners & operators?

If suppliers don’t currently charge VAT, the UT’s decision may lead them to increase their prices by 20% to account for VAT.

Suppliers may also seek to recover VAT from their customers that should have been charged on historical supplies. This could leave dental practice owners and operators with potential exposure under their commercial contracts, particularly where they're unable to recover the corresponding input VAT.

What does this mean for dental laboratories?

Provided that the VAT registration threshold is met (currently £90,000 of turnover in any rolling 12-month period), VAT should be applied to all supplies of aligners and similar products made to dental practice owners, operators or dental technicians, rather than directly to patients as part of dental treatment.

Could the position change again?

The overall VAT position isn't fixed yet. Align may yet appeal the UT's decision to the Court of Appeal.

Next steps

For dentists

1. Identify whether VAT has been charged by suppliers on supplies of dental aligners received. 
2. Review contracts with suppliers to understand any potential liability.
3. Assess whether there’s a level of exposure if suppliers seek to recover VAT that should have been charged historically. 

For dental laboratories & suppliers

1. Confirm your VAT registration position, whether you’re VAT registered or should be registered. 
2. Identify whether VAT has been charged historically or should have been charged and if liabilities exist.
3. Remediate your VAT position with HMRC where VAT should have been charged but wasn't.

How we can help

Our tax disputes, commercial and dental sector experts can:

• Review and identify potential VAT exposure and registration requirements.
• Review commercial contracts.
• Advise on disclosures of unpaid VAT liabilities to HMRC.
• Support on commercial disputes arising between suppliers and dental care providers.

Talk to us by emailing hello@brabners.com, calling 0333 004 4488 or filling out our contact form